Sunitinib (Sutent ®)
Sunitinib (Sutent ®) is a targeted therapy used to treat renal cell carcinoma in the kidney, gastrointestinal stromal tumours (GISTs) and pancreatic neuroendocrine tumours. It may be used in research trials for other cancers too.
Sunitinib (Sutent ®) is a targeted therapy. It is used to treat renal cell carcinoma in the kidney, gastrointestinal stromal tumours (GISTs) and pancreaticve neuroendocrine tumours. It may beused to treat other cancers as part of a research trial.
Sunitinib works by blocking (inhibiting) signals in the cancer cells that make them grow. Blocking the signals causes the cells to die. Sunitinib can also stop cancer cells from developing new blood vessels. This reduces their supply of oxygen and nutrients so the tumour shrinks or stops growing. Drugs that interfere with blood vessel growth are called angiogenesis inhibitors or anti-angiogenics.
When sunitinib is used
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Sunitinib is used to treat kidney cancer (renal cell carcinoma), gastrointestinal stromal tumours (GISTs ) or pancreatic neuroendocrine cancers that can’t be removed by surgery and/or have spread. It may be used to treat other cancers as part of a clinical research trial.
Sunitinib may only be available in some situations. Your cancer doctor can tell you whether it’s appropriate for you. Some people may be given it as part of a clinical trial. If a drug isn’t routinely available on the NHS, there may be other ways you can get access to it. Your cancer doctor can give you advice.
Taking sunitinib tablets
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You take sunitinib with a glass of water at the same time each day. It can be taken with or without food, but don’t take it with grapefruit or grapefruit juice. You usually take sunitinib for as long as it is controlling the cancer.
Always take your tablets exactly as your nurse or pharmacist explained. This is important to make sure they work as well as possible for you.
If you have kidney cancer or a GIST, you will usually take sunitinib once a day for four weeks, followed by two weeks without the drug. This makes up a cycle of treatment that lasts for six weeks.
If you have a pancreatic neuroendocrine tumours (pancreatic NETs), you will usually take sunitinib once a day, with no days off treatment.
There are some important things to remember when taking your tablets:
If you forget to take your tablets, take them as soon as you remember. If it’s nearly time for your next dose, forget about the missed one and carry on as normal. Don’t take a double dose.
Keep tablets in the original package.
Keep them safe and out of the reach of children.
Get a new prescription before you run out of tablets and make sure you have plenty for holidays.
Return any unused tablets to the pharmacist if your treatment is stopped.
If you’re sick just after taking the tablets, let your doctor know. You may need to take another dose. Don’t take another dose without telling your doctor, nurse or pharmacist first.
Possible side effects of sunitinib
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We have included the most common side effects of sunitinib here. We haven’t included all the less common and rarer side effects. You may get some of the side effects we mention, but you will not get them all.
The side effects of sunitinib are generally mild to moderate and may get better during treatment as your body adjusts to the medicine. Sometimes, if a side effect is more severe, your doctors may need to reduce the dose of sunitinib or stop the treatment for a short time. Very rarely, people may need to stop having the treatment completely.
Your doctor can prescribe drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist has explained. This will help the drugs work as well as possible for you.
Your nurse will give you advice about managing side effects. After your treatment is over, side effects will start to improve. Always tell your doctor or nurse about the side effects you have.
Serious and life threatening side effects
Sometimes cancer drugs can result in very severe reactions, which rarely may be life threatening.Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time day or night. Save these numbers in your phone or keep them somewhere safe.
Common side effects of sunitinib
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Each person’s reaction to treatment is different. Some people have few side effects while others may experience more. The side effects described here won’t affect everyone having this treatment.
We’ve outlined the most common side effects but haven’t included those that are very rare and therefore unlikely to affect you. If you notice any effects that aren’t listed here, discuss them with your doctor or specialist nurse.
This is a very common side effect. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise such as short walks, which will help. If tiredness is making you feel drowsy, don’t drive or operate machinery.
Changes in your bowel habits
The most common change in bowel habit is frequent loose bowel movements (diarrhoea) but some people become constipated. Diarrhoea can usually be controlled with medicine. If you have diarrhoea, it’s important to drink plenty of clear fluids (8–10 glasses a day). If you have constipation, increasing your intake of fibre, fruit and fluids may help.
Sometimes sunitinib can cause tummy (abdominal) pain. Tell your doctor if you have any pain,changes in your bowel habits or bleeding from the back passage.
Effects on blood cells
Sunitinib can reduce the number of blood cells in your blood. You will have regular blood tests to check your blood cell numbers.
Risk of infection
If you have a low number of white blood cells, you are more likely to get an infection. If this happens during your treatment, your doctor or nurse will advise you how to reduce your risk of infection. Rarely, your doctor may also ask you to stop taking your tablets for a short time until your white blood cell numbers recover.
Contact the hospital straight away if:
your temperature goes over 37.5°C (99.5° F) or over 38°C (100.4° F), depending on the advice given by your healthcare team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot or a painful, swollen area of skin.
Anaemia (low number of red blood cells)
Sunitinib can reduce the number of red blood cells in your blood. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.
This drug may increase bleeding. You may have nosebleeds and bruise more easily.
Bleeding is usually mild but sometimes can be very serious. If you cough up blood, see blood in your urine, have black stools (black poo), have a sudden severe headache, feel confused or have any other unusual bleeding contact your doctor straight away.
Feeling sick (nausea) and being sick
Your doctor can prescribe anti-sickness drugs to prevent, or greatly reduce sickness.
If you continue to feel or be sick, tell your doctor. They can prescribe different anti-sickness drugs that may work better for you.
Loss of appetite
If your appetite is affected, try to eat smaller meals more often. If you’re finding it difficult to eat enough, ask to speak to a nurse or dietitian. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
Effects on your mouth
Your mouth may become sore or dry, less commonly you may develop mouth ulcers. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush can help. Tell your nurse or doctor if you have mouth problems. They can prescribe mouthwashes and medicine to help.
If your sense of taste is affected, you may need to experiment with different types of food to find what tastes best to you. Your nurse can give you advice on coping with taste changes.
Changes to your hands and feet
You may develop redness on the palms of your hands and soles of your feet. Sometimes the hands and feet become sore or swollen. There may also be changes in sensation, such as numbness or tingling. If your hands or feet are affected, tell your doctor. They may give you lotions, moisturisers or painkillers. Keep your hands and feet cool, and avoid hot water and tight shoes. Wear gloves to protect your hands when doing housework or gardening.
Effects on skin
The medicine in sunitinib is yellow and it may make your skin look yellow. Your skin may also be come lighter in colour. Some people get a rash, or notice skin redness, dryness or itching.Tell your doctor or nurse if your skin is affected. They may give you treatments to help such as lotions, moisturisers or painkillers.
Very rarely, people may have a severe skin reaction. The symptoms can include large blisters, peeling skin, sores in your mouth. You may also have a fever (high temperature). You must contact the hospital straight away if this happens, as it may cause very serious problems.
Effects on hair
Your hair may become lighter in colour. Sometimes hair becomes thinner during treatment.
High blood pressure
Sunitinib can cause high blood pressure in some people. You will have your blood pressure checked regularly. Some people may need to take tablets to control their blood pressure. Occasionally, if blood pressure is too high and cannot be controlled, sunitinib may be stopped permanently.
If you already have high blood pressure and are on treatment to control it, you will have regular blood pressure checks. This is to make sure your blood pressure remains well controlled during treatment with sunitinib. Talk to your doctor if you have any concerns.
Build-up of fluid
Some people develop swelling in their arms or legs or around the eyes because of fluid buildup. Tell your doctor if you notice this. They may prescribe drugs that make you pass more urine (diuretics) to help get rid of some of the fluid.
Some people have indigestion or acid reflux (acid comes up from the stomach into the gullet) when taking sunitinib. Tell your doctor if you are affected as they can prescribe treatment to help.
Sunitinib can affect the thyroid gland. You will have regular blood tests to check how well your thyroid is working during treatment. Possible symptoms of thyroid changes include: tiredness, feeling depressed, difficulty concentrating, weight gain, constipation, feeling cold, dry skin and dry hair. If you notice any symptoms, let your doctor know.
Sunitinib may cause headaches. If you have more frequent or severe headaches than usual, let your doctor or nurse know.
Cough or breathlessness
You may feel breathless or develop a cough. Contact your doctor for advice if you develop these symptoms.
Back pain or joint pain
Some people have back pain or joint pain while having treatment. Less commonly, sunitinib can cause muscle pain or cramps. Your doctor can prescribe painkillers to relieve pain.
Sunitinib can affect sleep in some people. Tell your doctor if you are having difficulty sleeping.
Less common and rare effects of sunitinib
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Sunitinib may cause dizziness. Tell your doctor or nurse if this is a problem. Don’t drive or operate machinery if you are affected.
Sunitinib may cause heart changes but these are usually mild and go back to normal when treatment stops. Tell your doctor if you have had heart problems in the past. If you have pain or tightness in your chest, changes in your heartbeat, swelling of your feet and ankles, or feel dizzy or breathless contact your doctor straight away. These symptoms can be caused by other conditions but it’s important to get them checked by a doctor.
Changes in kidneys or liver
In some people, sunitinib can affect their kidneys or liver. This is usually mild and goes back to normal after treatment. You will have regular blood tests to check your kidneys and liver. Tell your doctor if there are changes in how often you are passing urine or if you stop passing urine.
Sunitinib may cause a blood clot. This may cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Jaw problems (osteonecrosis)
This is a rare side effect. Healthy bone tissue in the jaw can become damaged and die. This is called osteonecrosis of the jaw. It mainly affects people who have had recent treatment with a type of drug used to strengthen the bones given into a vein (intravenous bisphosphonate).
Gum disease, problems with your dentures and some dental treatments, such as having a tooth removed, can increase the risk. So before you start taking sunitinib you may be advised to have a full dental check-up.
During treatment, it’s important to look after your teeth by brushing them regularly and having routine dental check-ups. Always let your dentist know that you’re taking sunitinib.
Some of the symptoms of osteonecrosis can include: pain, swelling, redness of the gums, loose teeth or a feeling of numbness or heaviness in your jaw. Tell your cancer specialist and dentist straight away if you have any of these symptoms.
Tumour lysis syndrome (TLS)
Rarely sunitinib may cause the cancer cells to break down very quickly and release uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid but may not be able cope with large amounts. This can cause chemical imbalances in the blood that affect the kidneys and the heart. Doctors call this tumour lysis syndrome (TLS).
People who have a higher risk of TLS may be given tablets called allopurinol (Zyloric®) or a drug called rasburicase through a drip, when they start treatment.
If you are going to have an operation
Wounds may take longer to heal while you’re having treatment with sunitinib. You may need to stop taking sunitinib before the operation and not start taking it again for a few weeks afterwards.Your doctor will give you more advice.
If you have diabetes
Sunitinib may lower blood sugar levels. If you have diabetes, you may need to check your blood sugar levels more often. Your doctor will talk to you about how to manage this.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Other information about sunitinib
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Food and medicines
You should avoid grapefruit and grapefruit juice and the herbal remedy St John’s Wort during treatment with sunitinib. This is because they can make it less effective. Some other medicines, including those that you can buy in a shop or chemist, can be harmful to take when you’re having sunitinib. Tell your doctor about any medicines you’re taking, including over-the-counter drugs, supplements, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It’s important to discuss fertility with your doctor before starting treatment.
Little is known about the effects of sunitinib on a developing baby. Women who could become pregnant are advised to use an effective form of contraception during treatment and for some months afterwards. Therefore, it is not advisable to become pregnant.
Sunitinib may be present in breast milk. Women are advised not to breastfeed during treatment and for a few months afterwards.
If you’re admitted to hospital, it’s important to tell the doctors and nurses looking after you that you are having sunitinib treatment. Always tell any doctors treating you for non-cancerous conditions that you are taking a course of sunitinib tablets, which should not be stopped or restarted without advice from your cancer specialist. You should tell them the name of your cancer specialist so they can ask for advice.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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